NPIMap

Organization Active NPI

Revolution Medical Center, Inc

  • Primary Care Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1710169180
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
04836 Issued in AZ
Legal business name
REVOLUTION MEDICAL CENTER, INC
Practice address
2015 E Camelback Rd
Phoenix, AZ 85016-4710
Phone
(602) 840-4400
Fax
(602) 840-0490
NPI assigned
Nov 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jesse Sage Haggard, N.M.D.
Title
Clinic Director
Phone
(602) 463-7177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 04836 AZ Primary

Addresses

Primary practice location

2015 E Camelback Rd
Phoenix, AZ 85016-4710

Mailing address

2015 E Camelback Rd
Phoenix, AZ 85016-4710
Phone (602) 840-4400

National Provider Directory

National Provider Directory
Tax ID family
Revolution Medical Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1710169180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 E CAMELBACK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164710",
            "telephone_number": "602-840-4400",
            "fax_number": "602-840-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 E CAMELBACK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164710",
            "telephone_number": "602-840-4400",
            "fax_number": "602-840-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "HAGGARD",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "SAGE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "602-463-7177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N.M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "04836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.